Health Tips / Myotherapy

What Is It?

Myotherapy (“myo” is from the Latin for muscle) is a specialized form of muscle massage and stretching that uses deep manual pressure on specific spots on the body to release trigger points. Knots of tension, trigger points usually occur within a taut band of skeletal muscle or in the muscle’s fascia (connective tissue). Because they are painful upon compression, they can “trigger,” or cause, pain in other parts of the body. Myotherapy aims to relax these muscle knots and quickly relieve muscle-related pain.

Myotherapy grew out of myofascial trigger point therapy, which was pioneered in the early 1940s by Janet Travell, M.D., the White House physician to John F. Kennedy, and Dr. David G. Simons. Dr. Travell’s therapy (which she used to treat Kennedy’s back pain) involved injecting saline and a local anaesthetic (procaine), directly into the painful trigger points. She would follow the injections with a series of gentle stretches and a coolant spray.

In 1976, Bonnie Prudden, a leading authority on exercise and health, came upon what she later called myotherapy rather serendipitously. While assisting a Massachusetts doctor in preparing a patient for injection therapy, she unintentionally pressed too hard on one of the patient’s trigger points. Almost immediately the patient felt much better. Prudden began to theorize that trigger points could be released simply by applying manual pressure. She was soon on the phone to her friend Travell, who encouraged her to experiment further with her theory. Prudden’s efforts were met with great success as many patients reported dramatic improvements in a shorter time than with the invasive injections.

Over the next ten years, Prudden gradually developed a training system for practitioners of the myotherapy. Today “Bonnie Prudden Myotherapy” (see “How to Choose a Practitioner,” below) is the most widely known certification program for myotherapists in the U.S. and abroad. There are, however, other training programs that teach the principals of myotherapy to those in the massage, physical therapy, and pain management professions.

How Does It Work?

According to practitioners of myotherapy, trigger points can result from birth trauma, falls, strains, sprains, disease, occupation, or misuse or overuse of certain parts of the body. Even though trigger points may lie dormant for years, they can “fire” and cause the muscle to go into painful spasm in the presence of physical or emotional stress. Repeated spasms can keep the muscle continually contracted, not only causing ongoing pain, but also interfering with posture, balance, and muscle function. Myotherapy uses manual pressure to break this cycle of muscle spasm and pain.

In the Bonnie Prudden system, the body is divided into five zones with 17 distinct segments. Each segment contains several trigger points, and pain in a certain area of the body corresponds to specific trigger-point segments. If you have back pain, for example, all the trigger points on your back as well as on the front of your torso would be “erased,” or treated, to relax the affected muscle and get rid of the pain.

Using a systematic hands-on investigation of your body, the myotherapist will look for the tense and painful trigger points that specifically relate to your problem. To treat the affected trigger points, the practitioner will apply pressure with the fingers, knuckles, and/or elbows to each point for five to seven seconds. The pressure will probably feel painful at first, but, according to those who have experienced treatment, it often brings about immediate pain relief.

What You Can Expect

An initial visit to a myotherapist could last up to 90 minutes. Subsequent treatment sessions are about an hour. On the first visit, the practitioner will take an extensive history to help determine where your trigger points are. You will be asked questions about your occupation, recreational activities, and other pastimes. Your muscle strength and flexibility will also be evaluated.

The practitioner will then spend the remainder of the session treating your trigger points. While the initial pressure on a trigger point may result in a loud “Ow!” most people describe the pressure as “feel-good” pain. This is because stimulation of the body in this manner releases natural analgesic chemicals known as endorphins, and the treatment gets less and less uncomfortable as the session progresses.

Because developing flexibility and strength is a key component of myotherapy, the practitioner will also stretch your affected muscles and teach you some corrective exercises to do at home. While you may find the exercises painful at first, they need to be done several times a day for myotherapy to be effective. As you gradually recover, the exercise program may be expanded into a program of general fitness. Indeed, most myotherapists try to promote a sense of personal responsibility in their patients, encouraging them to exercise more, eat a proper diet, and be conscious of the stresses in their lives.

Most people seeking myotherapy need about five sessions to feel better. However if you suffer from a myofascial pain syndrome such as fibromyalagia, you may need regular treatments over a much longer period of time, depending on the basic cause of the pain and the number of flare-ups.

Some physicians working with myotherapists may suggest trigger point injections either before or after your massage session. Only an M.D.or D.O. can administer such a treatment, however.

Health Benefits

As with many other hands-on treatments for muscle pain disorders, clinical studies on myotherapy’s effectiveness are lacking. Case reports do suggest that myotherapy can help all types of muscle-related pain, including back, shoulder, and neck pain; tension and migraine headaches; menstrual cramps; repetitive motion injuries such as carpal tunnel syndrome; temporomandibular joint syndrome (TMJ); and injuries caused by accidents or playing sports.

One of the most popular uses of myotherapy is for fibromyalgia, a rheumatic disorder characterized by widespread muscle pain and fatigue. Doctors are not sure exactly how the so-called “tender points” of fibromyalgia develop, but for most people it is probably a muscular reaction to chronic stress. If you choose to use myotherapy for fibromyalgia, make sure the treatment is performed when the involved muscle is as relaxed as possible. If your muscle is in spasm or very tense, the treatment will be too painful. Myotherapy is also excellent for myofascial pain syndromes other than fibromyalgia. These can follow an injury such as whiplash, or occur because of some sort of misalignment in the skeleton.

The therapy has also been used to treat impotence and incontinence resulting from spasms in the muscles of the pelvic floor. Some people suffering from lupus, arthritis, and multiple sclerosis, which all affect muscles that house trigger points, have also found pain relief.

Some chiropractors and osteopaths recommend myotherapy as an useful complement to spinal adjustments. It is felt that once the trigger points are erased, and muscle movement increases, the spinal adjustment has a better chance of staying in place. The therapy can also complement craniosacral therapy, Rolfing, certain forms of physical therapy, and acupuncture. In addition to pain relief, myotherapy my also produce a dramatic increase in mobility, flexibility, and stamina. Posture, gait, and sleep patterns may improve as well.

How To Choose a Practitioner

You can find a certified Bonnie Prudden Myotherapist through the Bonnie Prudden School for Physical Fitness and Myotherapy in Tucson, Arizona. Certified Bonnie Prudden myotherapists must train for 1,300 hours over a nine-month period, pass a board certification exam, and update their training every two years. In some states, myotherapists are also required to earn a massage therapy license.

If your myotherapist hasn’t been certified in the Prudden method, be sure to inquire about his training and experience. A good myotherapist should be highly knowledgeable in the areas of musculoskeletal anatomy, kinesiology, corrective and therapeutic exercise, and myofascial dysfunction. Be aware, however, that most myotherapists will not have had comparable biomedical and psychological training to physical therapists, nurses, and chiropractors. Myotherapists are not qualified to diagnose and treat internal illnesses or serious emotional disorders that can cause muscle pain. It is therefore important to discuss the therapy with your primary-care physician before beginning treatment.

Some insurance companies cover the cost of myotherapy if the patient is referred by a physician or if the practitioner’s treatments are supervised in the office of a licensed physical therapist. Check with your plan benefits office. Typically insurance plans that do cover these treatments require your doctor to make a written referral, stating your diagnosis, listing exactly what’s going to be done, and requesting a specific number of sessions (usually six to eight) at one hour each. Even if myotherapy is not covered by your health plan, it’s a good idea for your doctor to confer with you and your myotherapist about your progress.


Myotherapy addresses only muscle-related pain. Be sure to seek standard care for pain caused by a tumor, broken bone, or other nonmuscular cause.

If you have fragile blood vessels caused by leukemia and certain other disorders, you should avoid myotherapy.

Pressure should not be applied to a recent fracture, a surgical incision, or a tumor.

Avoid myotherapy if you have any condition that is aggravated by deep pressure, such as a fibromyalgia flare-up.

Be well,
David Edelberg, MD